Developing an implementation strategy for the use of objective adherence data in routine clinical practice: a case study in cystic fibrosis clinics (abstract only)

Background Preventative inhaled treatments preserve lung function and prolong life in Cystic Fibrosis (CF). An online platform (CFHealthHub) has been developed with patients and clinicians to support treatment habits. Self-report adherence to these treatments is over-estimated. CFHealthHub displays real-time objective adherence data from dose-counting nebulisers, so that clinical teams can offer informed treatment support. In this paper, we used the theoretical domains framework (TDF) to identify implementation barriers to health professionals accessing objective adherence data through CFHealthHub. In 2019, scale up of implementation is required in a further 19 CF centres. Method Qualitative data were collected through semi-structured interviews with health professionals in three participating UK CF centres. The participants (n=13) were purposively sampled based on location and professional category. A topic guide was created exploring all theoretical domains. Transcripts were analysed by two researchers using framework analysis. Results Interviews demonstrated that participants did not have routine habits for using adherence data in clinical care. Analysis indicated that an implementation strategy should address all 14 domains to successfully support implementation scale up. Participants reported insufficient training and low confidence in using adherence data. As a result, participants reported negative beliefs that adherence data would be used to “tell patients off”. In addition, participants frequently justified lack of engagement because they believed adherence was primarily a physiotherapist responsibility. Environmental barriers, such as computer access and pressures on staff time were common. Participants thought environmental and social influence barriers could be addressed by dedicated senior management. Conclusion The identified barriers supported the development of an implementation strategy using the behaviour change wheel. The strategy includes support for habit formation and other barriers using intervention functions, such as environmental restructuring, enablement, education and modelling. The success of this strategy will be evaluated as the project opens in new CF centres.